CLINICAL SIGNS:
* fever variable without particularity, elevated with chills in acute forms.
* appearance or aggravation of a heart murmur.
* alteration of the general state, slimming, arthralgia.
* fake osaris parsley painful and fleeting.
* moderate inconstant splenomegaly.
* rarely, erythematous palmoplantar eruption.
* complications:
– acute heart failure with OAP.
– atrioventricular conduction disorders.
– cerebral or coronary septic emboli.
* any unexplained fever> 8 days in a known valve, any appearance or modification of a breath should be considered as an infectious endocarditis.
ETIOLOGY:
* Staphylococcus, streptococcus, Gram-bacillus, yeast infection following:
– dental care .
– skin ulcer, burn, eczema .
– sinusitis, otitis.
– intravenous injection (drug addicts).
– endoscopy, cystoscopy, abortion, colonic surgery, urinary catheterization, …
* contributing factors:
– Valvular prosthesis , valvulopathies
– congenital heart disease, obstructive cardiomyopathy.
DIAGNOSTIC TESTS:
* blood cultures .
* ECBU, NFS, VS, CRP.
* echocardiography as soon as possible: images of vegetation, image of underlying heart disease.
TREATMENT:
* venous route: G5%.
* high dose antibiotic for 15 days:
– first-line: aminoglycoside, 1.5 mg / kg x 2 / d + Penis G, 20-30 M / d IV.
– according to the antibiogram if possible:
– aminoglycosides + Bristopen 8g / d IV if methicillin-sensitive staphylococcus.
– aminoglycosides + C IIIG if gram negative bacillus.
– if allergy to penicillin: Vancomycin: 15 mg / kg x 2 / d.
* in some cases, surgical correction of the valve:
– hot or delayed.
* prevention of subjects at risk: Clamoxyl, 3 g one hour before dental care or an instrumental gesture (Pyostacine: 1 g if allergy to penicillins).
